Individual
MICHELLE BRAVO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
19 BRADHURST AVE STE 3100N, HAWTHORNE, NY 10532-2140
(914) 493-7000
Mailing address
100 WOODS RD, VALHALLA, NY 10595-1530
(914) 493-7000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
310127
NY
208600000X
Surgery Physician
LP02787
RI
390200000X
Student in an Organized Health Care Education/Training Program
LP02787
RI
Other
Enumeration date
05/30/2013
Last updated
06/21/2022
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